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At least 1,027 records · Page 57Linked to original sources
PubMed2004

Evaluating infection control practices among dentists in Vâlcea, Romania, in 1998.

OBJECTIVES: To evaluate infection control knowledge and practices, provide training on universal-standard precautions (USP), and improve infection control knowledge and practices among dentists. SETTING: Private and public dental offices in Vâlcea, Romania. METHODS: Information about the use of hepatitis B vaccine, knowledge of and training in USP, perceived risks of disease transmission, and infection control practices was gathered from a sample of dentists through interviews, direct observations, and a survey administered during a training session. RESULTS: Interviews among dentists and direct observations of infection control practices revealed that resources were often scarce in public clinics; however, availability of supplies in private or public clinics often did not correlate with adherence to proper infection control. Of 125 registered dentists, 46 (37%) attended the session and completed the survey. Of these, 75% worked in public clinics, 40% in private practices, and a few in both. More than 50% believed that the prevalence of hepatitis B virus (HBV) was low in their patients compared with the Romanian population. Only 26% of dentists had received hepatitis B vaccine. Dentists reported a mean of six percutaneous injuries a year. Most (89%) reported that gloves were effective in preventing HBV transmission; 24% wore them for every patient. Most used dry heat sterilization; however, chemical disinfectants were also used. CONCLUSIONS: Resources were limited, receipt of hepatitis vaccine was low, and infection control knowledge and practices varied. Training and education are needed regarding the importance of USP, hepatitis B vaccination, and alternative practices when resources are insufficient.

Adult↗
PubMed1998

Practical precautions for avoiding sharp injuries and blood exposure.

Current surgical practices result in greater than a 50-percent incidence of blood exposure per operation for surgeons and operating team members who do not take any added precautions during their procedures. By incorporating changes in personal exposure protection, double gloving, and developing safer techniques during operations, it is estimated that the exposure risk to blood and body fluids can be decreased among surgeons by 74 percent. This article reviews practice precautions that may be acquired by the surgeon and the operating team. The current U.S. Health Department information on HIV risk after sharp exposure is reviewed as well as the most recent recommendations for antiviral drug prophylaxis after significant exposures.

Blood↗
PubMed2006

Combination forceps fuse both safety and efficiency.

BACKGROUND: Instrumentation prevents needle stick injury. OBJECTIVE: To review forceps that insure safety and facilitate tissue-handling and knot-tying efficiency. METHOD: Medical literature reports were reviewed using Ovid. Commercially available instruments were qualitatively tested. RESULTS: Suture platforms securely hold suture needles and can be used during knot tying. A wide range of combination forceps have been invented and can be broadly categorized as either skin hook or toothed combination forceps. CONCLUSIONS: Combination forceps fuse both efficiency and safety. Skin hook forceps may eventually be the optimal combination instrument, but toothed combination forceps are recommended.

Equipment Design↗
PubMedDate not supplied

The management of sharps in the emergency department: is it safe?

In this study, we observed the management of sharps by health care workers including physicians, nurses, technicians, and students in the Emergency Department of the University of California-San Diego Medical Center. Twenty-eight percent of 418 observed sharp utilizations were managed in such a way that excess risk was conferred to the user, another person, or both. Twenty-seven percent conferred excess risk to the user and 12% to another person. Twenty percent of 322 recappable needles were recapped using a two-handed technique; 64% were disposed of uncapped. Four sharps (1%) were inadvertently thrown in the trash. Of the 418 observed sharp utilizations, none resulted in a puncture wound, although the four that were thrown in the trash represent a very high risk of injury to others. Physicians were observed handling the highest percentage of sharps in manners associated with excess risk while technicians and students managed sharps with the least risk. Among sharps used on patients who were IV drug abusers with unknown HIV status, 29% (n = 28) were handled with excess risk to the user, another person, or both. Of 24 sharps used on known HIV-infected patients, there were no practices observed that subjected either the user or another person to excess risk.

California↗
PubMed2003

Potential exposure to hepatitis C virus through accidental blood contact in interventional radiology.

PURPOSE: To quantify the prevalence of accidental blood exposure (ABE) among interventional radiologists and contrast that with the prevalence of patients with hepatitis C virus (HCV) undergoing interventional radiology procedures. MATERIALS AND METHODS: A multicenter epidemiologic study was conducted in radiology wards in France. The risk of ABE to radiologists was assessed based on personal interviews that determined the frequency and type of ABE and the use of standard protective barriers. Patients who underwent invasive procedures underwent prospective sampling for HCV serologic analysis. HCV viremia was measured in patients who tested positive for HCV. RESULTS: Of the 77 radiologists who participated in 11 interventional radiology wards, 44% reported at least one incident of mucous membrane blood exposure and 52% reported at least one percutaneous injury since the beginning of their occupational activity. Compliance with standard precautions was poor, especially for the use of protective clothes and safety material. Overall, 91 of 944 treated patients (9.7%) tested positive for HCV during the study period, of whom 90.1% had positive viremia results, demonstrating a high potential for contamination through blood contacts. CONCLUSIONS: The probability of HCV transmission from contact with contaminated blood after percutaneous injury ranged from 0.013 to 0.030; the high frequency of accidental blood exposure and high percentage of patients with HCV could generate a risk of exposure to HCV for radiologists who perform invasive procedures with frequent blood contact. The need to reinforce compliance with standard hygiene precautions is becoming crucial for medical and technical personnel working in these wards.

Blood-Borne Pathogens↗
PubMed1999

Catastrophic arterial reactivity during primary antiphospholipid syndrome--a case report.

Arterial reactivity leading to acute thrombosis at the site of a needle stick injury has never been described during antiphospholipid syndrome. The authors report a case characterized by a succession of thrombotic events occurring during or immediately after arterial angiographies or arterial surgery, in which catastrophic arterial reactivity can be strongly suspected. In this particular patient, it can be postulated that damage to the endothelial cells of the vessels injured during manipulation may have precipitated or aggravated the preexisting susceptibility to thrombosis.

Adult↗
PubMed2005

[Occupational exposures with risk of transmission of HIV, HBC and HCV in health care workers].

Health care workers are often victims of occupational injuries by contaminated sharps or projection of contaminated fluids to mucous membranes and are therefore at risk for transmission of HIV, HBV and HCV. Every technical and organisation-related measure useful to prevent injuries should be implemented and personal protection equipment must be made available to workers. Promotion of hepatitis B immunization is a key issue. Immediate evaluation of injured employee is necessary to assess the risk related to exposure and the indication for post-exposure prophylaxis (anti-retroviral therapy for HIV, immunoglobulins and vaccination for hepatitis B). When a health care worker has been exposed to one of the blood-born viruses, thorough information and follow-up should be offered by a specialist.

HIV Infections↗
PubMedDate not supplied

Controlling infection potentials when passing surgical instruments.

1. Recent research suggests that percutaneous injury occurs in 6.9% of observed surgical procedures. This finding indicates that percutaneous injuries occur often during surgery, placing OR personnel at risk for infection potential with bloodborne pathogens. 2. One approach to reducing the risk of injury with contaminated sharps is to introduce a change in the normal method of passing sharps. A new method, the "hands-free" technique, focuses on the safety of the OR professional without disrupting the established routine of the operating room. This new technique is designed to reduce the number of "collisions" between sharps and OR professionals. 3. Caution and staff education are important during any attempt to use hands-free instrument passing techniques in an OR setting. The hands-free technique of passing sharps should be practiced until all members of the surgical team have a high degree of comfort using it.

Humans↗
PubMed2003

Occupational exposure to HIV infection in health care workers.

BACKGROUND: The aim of this study was to determine the epidemiology of occupational exposure to HIV infection in health care workers (HCWs). MATERIAL/METHODS: A survey from 4 hospitals between February 1995 and May 2001 identified 28 HCWs who had been exposed to HIV. The type of exposure to HIV, the circumstances of the incident, the safety precautions applied, and epidemiological information were evaluated in each case. A blood specimen for HIV serological testing was collected at the baseline visit and at 6 weeks, 3 months, 6 months and 12 months follow-up. RESULTS: The study population consisted of 24 women and 4 men, mean age 34.7 +/- 5.8, including 15 nurses, 9 physicians, 2 nursing assistants, 1 morgue worker, and 1 medical student. These workers had been exposed to blood and infectious body fluid from patients who had AIDS (17 exposures), were HIV-antibody positive and symptomatic (3 exposures), or were HIV-antibody positive and asymptomatic (8 exposures). The exposure types included percutaneous injury (22) and blood or infectious body fluid contact with mucous membranes (2) or intact skin (4). Post-exposure chemoprophylaxis was used by 18 HCWs, 12 of whom reported side effects. None of the HCWs was HIV-seropositive in follow-up after occupational exposure. CONCLUSIONS: Nurses are most at risk for occupational exposure to HIV infection. Post-exposure chemoprophylaxis is effective. Routine post-exposure management is also a good instrument to detect serological markers of HBV and HCV infection among HCWs and patients.

Adult↗
PubMed2005

Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings.

BACKGROUND: Approximately 3 million health care workers (HCWs) experience percutaneous exposure to bloodborne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus (HIV) infections annually. More than 90% of these infections are occurring in low-income countries, and most are preventable. Several studies report the risks of occupational BBV infection for HCWs in high-income countries where a range of preventive interventions have been implemented. In contrast, the situation for HCWs in low-income countries is not well documented, and their health and safety remains a neglected issue. OBJECTIVE: To describe the extent of occupational exposure to blood and the risk of BBV infection among a group of HCWs in rural north India. METHODS: A cross-sectional survey of HCWs from 7 rural health settings gathered data pertaining to occupational exposure to blood and a range of other relevant variables (eg, demographic information, compliance with Universal Precautions, perception of risk, knowledge of BBVs). A mass action model was used to estimate the risk of occupational BBV infection for these HCWs over a 10-year period. RESULTS: A total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3) and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last year were hospital site, job category, perception of risk, and compliance with Universal Precautions. CONCLUSION: The high level of occupational exposure to blood found among this group of rural north Indian HCWs highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of BBVs.

Accidents, Occupational↗
PubMed2003

Sharps injury reduction using Sharpsmart--a reusable sharps management system.

Sharps containers are associated with 11-13% of total sharps injuries (SI) yet have received little attention as a means of SI reduction. A newly developed reusable sharps containment system (Sharpsmart) was trialed in eight hospitals in three countries. The system was associated with an 86.8% reduction of container-related SI (CRSI) (P=0.012), a 25.7% reduction in non-CRSI (P=0.003), and a 32.6% reduction in total SI (P=0.002) compared with historical data. The study concludes that the Sharpsmart system is an effective engineered control in reducing SI.

Accidents, Occupational↗
PubMed1997

Technology assessment--who is getting stuck, anyway?

Some 13% to 62% of all injuries reported to hospital occupational health workers are traceable to phlebotomy procedures. However, the selection of a needleless system is complex. The informed manager seeks answers to the following questions: (1) Do needleless systems reduce the risk of seroconversion to bloodborne pathogens? (Answer yes.) (2) Does the use of a needleless system affect patients' risk of catheter sepsis? (Answer no.) and (3) What about chemical compatibility with the newer materials used in needleless systems? (New variables require more studies.) The author lists references, manufacturers and some of the chemicals to which some manufacturers have exposed their devices.

Blood Specimen Collection↗
PubMed1993

A clinical evaluation of a blood conservation device in medical intensive care unit patients.

OBJECTIVES: This study was designed to a) document the efficacy of a device intended to conserve blood in critically ill patients; b) determine the effect of this blood conservation on hemoglobin concentration and the need for blood transfusions; c) determine if the blood conservation device resulted in interference with arterial pressure waveforms; d) determine if use of the blood conservation device resulted in a difference in the number of accidental needle punctures suffered by healthcare workers. DESIGN: Prospective, randomized, controlled trial. A clinical trial using prospective, random allocation of consecutive eligible patients. SETTING: The medical intensive care unit (ICU) of a university hospital located in a large metropolitan area. PATIENTS: A total of 100 patients who were admitted to the medical ICU, required arterial line monitoring for clinical purposes, and were managed by the ICU medical service. Exclusion criteria included active bleeding or chronic renal failure at the time of ICU admission. INTERVENTIONS: Patients in the experimental group had a blood conservation device incorporated into the arterial pressure monitoring system, while patients in the control group received a conventional arterial pressure monitoring system. MEASUREMENTS AND MAIN RESULTS: Data gathered included: age; gender; ICU discharge status; the duration of ICU stay; time in the study; volume of all blood drawn, discarded, or lost due to leakage; hemoglobin concentrations; blood transfusions; and accidental needle injuries. Arterial pressure waveforms were recorded and inspected for dampening or other deformation. Mean hemoglobin concentrations were compared on ICU admission and at 12-hr intervals. Demographic and clinical characteristics of the two groups were not significantly different. The volume of blood drawn and discarded from arterial catheters was significantly lower in the blood conservation group (blood conservation device: 5.7 +/- 7.5 mL; control: 96.4 +/- 88.5 mL; p < .0001), as was the total volume of blood discarded (blood conservation device: 19.4 +/- 47.4 mL; control: 103.5 +/- 99.9 mL; p < .0001). Mean hemoglobin concentration on admission was similar in the two groups (blood conservation device group: 11.8 +/- 2.5 g/dL; control group: 12.6 +/- 2.3 g/dL). In both groups, the mean hemoglobin concentration declined most rapidly in the first 24 hrs of ICU care and, thereafter, declined more slowly. Although the mean hemoglobin concentration was higher in the blood conservation group after 6 days, statistical significance was not reached until 9.5 days of ICU care. The mean change in hemoglobin concentration (overall: 1.2 +/- 2.2 g/dL) during the study represents a statistically significant (p < .0001) decrease of 9.7%. Hemoglobin concentration during the study decreased by 1.4 +/- 2.2 g/dL in the control group and 1.0 +/- 2.3 g/dL in the blood conservation group (p = nonsignificant). Univariate and multiple regression analysis demonstrated discarded blood volume to be a significant and independent predictor of the decline in hemoglobin concentration. Transfusion requirements were similar in both groups. The blood conservation system did not alter or interfere with pressure waveforms. There were no accidental needle injuries noted. CONCLUSIONS: The conservation of blood in critically ill patients must be a high-priority concern of all healthcare workers. Our data indicate that the blood conservation system eliminates a significant factor in the decline in hemoglobin concentration. With devices as described here, there is no reason to continue the practice of wasting the blood of critically ill patients in order to prevent preanalytic error.

Adult↗
PubMed2004

Occupational hazards among clinical dental staff.

Although identification of risks to dental healthcare workers has been explored in several industrialized nations, very little data is available from developing countries. This paper examines the occupational hazards present in the dental environment and reports survey results concerning attitudes and activities of a group of Nigerian dental care providers. A survey on occupational hazards was conducted among the clinical dental staff at the Dental Hospital of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife in Osun State, Nigeria. Thirty eight of the forty staff responded, yielding a response rate of 95%. Subject ages ranged from 26 to 56 years with approximately 25% in the 31-46 year old bracket. All of the staff were aware of the occupational exposure to hazards, and the majority had attended seminars/workshops on the subject. Only five staff members (13.2%) owned a health insurance policy and 26 (68.4%) had been vaccinated against Hepatitis B infection. All dentists (24) had been vaccinated compared with only two non-dentists; this relationship was significant (p= 30.07, chi2=0.000). Fourteen members of the clinical staff (36.8%) could recall a sharp injury in the past six months, and the majority (71.1%) had regular contact with dental amalgam. Wearing protective eye goggles was the least employed cross infection control measure, while backache was the most frequently experienced hazard in 47% of the subjects. The need for Hepatitis B vaccinations for all members of the staff was emphasized, and the enforcement of strict cross infection control measures was recommended. The physical activities and body positions that predispose workers to backaches were identified and staff education on the prevention of backaches was provided.

Adult↗
PubMed1997

HIV prophylaxis for health care workers.

The US Public Health Service (PHS) published new recommendations for preventing HIV seroconversion in health care workers suffering needle-stick injuries. In response, health care institutions across the United States are updating their internal protocols to meet the currently accepted standard of care in this area. We found the new guidelines lacking in critical definitions necessary to clarify practical applications in specific cases. We also found the recommendations of when to use one, two, or three drugs for post-exposure prophylaxis confusing. We report our university hospital's experience with needle-stick injuries over the past year. We propose modified guidelines that more finely stratify risk categories, define clinical variables which occur in practice, and simplify the algorithm for case management. The cost of managing our cases according to the modified guidelines are compared with management costs using the PHS guidelines. Potential costs of applying the PHS guidelines in our institution ranged from $68,994-$260,544; according to our modified guidelines, costs would range from $19,199-$54,749. We also present an analysis of the number of injured health care workers who need to be treated to prevent one case of seroconversion in the various risk stratifications.

Allied Health Personnel↗
PubMed1993

Fine-needle aspiration anchor. A simple device to prevent needle-stick injury at fine-needle aspiration.

Pathologists and clinicians performing fine-needle aspiration for cytologic diagnosis are at risk of finger injury by the needle during the aspiration procedure. To prevent this occurrence and its accompanying potential for transmitting serious pathogens such as the human immunodeficiency virus and hepatitis B virus, we have designed a simple acrylic device (fine-needle aspiration anchor) consisting of two curved prongs with an attached handle, to take up the functions of the fingers for stabilization of the target lesion. Use of the fine-needle aspiration anchor on more than 1000 patients with various mass lesions has confirmed enhanced immobilization of the lesions for aspiration, safety for the person performing the procedure, and excellent patient acceptance.

Biopsy, Needle↗
PubMed2005

Strategies for preventing sharps injuries in the operating room.

With the discovery of AIDS and HIV, the medical community began to widely recognize the dangers of serious illnesses spread-ing through contact with contaminated blood and body fluids. In response, the Centers for Disease Control and other groups have developed guidelines for the operating room to prevent the spread of infection from, for example, accidental needle sticks. Unfortunately, those guidelines are not always strictly followed. This article reviews studies that have examined precautionary practices, including such practices as double gloving, the use of blunt suture needles, and the use of neutral zones for passing sharps. The article also provides related sources for further information.

Accidents, Occupational↗